4th Trimester

Baby books and apps carefully guide you through the entire process of tracking your pregnancy week by week. Some even continue through how to care for baby in the hospital and when you get home. But I have found a gaping hole on the subject of postpartum care, especially for after coming home from the hospital. So much so, that I have made it a habit to create an after care basket for first time moms and include a little instructional chat. I have written briefly about postpartum care in the past here, but I want to elaborate and expand more.

No matter what your birth story looks like, you delivered a baby (or babies)! I have had four different birth experiences and through each process have learned something new. For starters, birth is a natural occurrence that has so many peculiar “normalcies” but can also be unpredictable. One woman’s uncomplicated birth may be completely different from the next, let alone from her fellow friend. So we can’t say “This was my experience so you don’t know what you’re talking about”. Some women experience all kinds of pre-labor including braxton hicks for months on end and prodromal labor for weeks that can sometimes turn intense like I did this time. On the other hand there are some women that don’t feel a thing until they are in active labor. I can’t speak about cesareans from personal experience but that is another basket full of varying experiences from planned to emergency. The bottom line is women need to be more supportive of each other and celebrate each birth story for the miraculous thing that it is, bringing a life into this world.

Part of that support needs to include being more vocal about all of the different experiences and challenges that the “4th trimester” brings. Our bodies change so much through out pregnancy and they don’t just go back over night. There is a whole new list of changes that need to take place as you heal, hormones plummet, and clothing sizes change (up and down).

 

Afterpains and Going to the Restroom

Some of the first things you will experience physically after giving birth are contractions that are often called afterpains and quite possibly a tricky trip to the restroom to urinate for the first time without a small(ish) human applying pressure.

The afterpains can feel as mild as bad period cramps and as strong as early labor contractions. They are effectively working to first constrict and close the blood vessels where the placenta was attached then to begin the weeks long process of shrinking the uterus back down to its original size called the involution of the uterus. With each pregnancy the afterpains can be increasingly stronger (they have for me). If your nurse offers additional pain medication and you are uncomfortable, by all means don’t try to be a hero! The plus side is that the afterpains subside over a couple of days and are typically strongest while nursing or pumping until they fade away completely.

Going to the restroom for the first time after giving birth can be a rather tricky affair, especially if you have had a catheter, additional swelling from extended pushing, tear, episiotomy, or any other potential variances. In my case, there was some swelling from delivering a larger baby which made me feel like an older gentleman with a prostate problem. There was the sensation of needing to urinate but my body wasn’t cooperating so I asked someone to turn on the sink while I used the peri bottle to help stimulate my body into action. Your nurse may offer stool softeners in the hospital, if not, I highly recommend adding one for a little while along with a high fiber diet to help smooth things over and reduce any unnecessary straining.

Once you get home it will take about a week before bathroom trips become less of an ordeal. It has been very helpful for me to have a postpartum care kit set up in my bathroom. Be sure to bring home that peri bottle along with pads, mesh panties, ice pack, medicated wipes, and chux pads if available. One thing that I tried differently this time was to start with depends for the first several heavy flow days and I don’t know why I didn’t try them sooner. As flow slowed down a little and I started to run low on the sassy underpants I switched to using them overnight and using underwear with big overnight high absorbency pads during the day. It is a good idea to have a variety of pads from extra heavy overnight to panty liners and a few options between. Another great thing to get is medicated wipes. They have witch hazel (a natural astringent) and cooling aloe which makes them the best thing to wipe with while everything is still tender and healing. Other cooling agents that you could employ include New Mama Butt Spray and Dermoplast Pain Relieving Spray.

 

Tenderness and Engorgement

Whether you nurse, pump, or choose to suppress lactation… you will most likely deal with some breast tenderness and possibly engorgement. I have done all three now and have dealt with varying degrees of engorgement each time. Cold application feels wonderful and warm (shower or wash cloth) helps stimulate let down.

If you are nursing, I suggest using the help of a lactation consultant to ensure a good latch to reduce nipple pain. It typically still takes you and baby about six weeks to get a good handle on things and for supply to even out but should be smooth sailing after that.

For pumping I highly recommend a good nipple cream before and after each session to keep things comfortable. Try not to pump too often when your breasts are painfully full unless you are trying to increase your ounces per day as this will create a demand.

Another thing to mention for nursing and pumping is weight. Some women experience weight loss during milk production and swear by it to help return to their pre-pregnancy weight. Unfortunately for others, myself included, our bodies hoard all the calories and actually gain weight while producing milk. Whichever way your body reacts, just remember to give yourself grace and not try to implement any drastic changes while nursing or pumping.

The category I am newest to and currently in the middle of is lactation suppression. From the time shortly after delivery, and daily since, I have taken a dropper full of sage and kept on a sports bra. I also made peppermint roller balls to apply after I came in contact with Samuel or heard him cry while I was in the hospital. Once my breasts started to fill I applied the peppermint more often, which was nice because it had a soothing menthol feeling. About that time was also when I asked my husband to pick up a head of cabbage so that I could start applying rinsed and dried leaves inside my sports bra. So far there have been about three really engorged days of rough discomfort. Today was the first day with some softer parts but they are still fairly full and sore as I’m not pumping.

 

Mental Health

This is a topic that I’ve grown passionate about over the past two years. One of the biggest invaluable resources is to have a support system in place and surrounding you before you deliver a baby. Having that support system to lean on if you need any kind of help … it’s huge. If you have a history of anxiety, depression, or postpartum depression, it is also excellent to have a therapist that specializes in birth trauma related issues. I have been blessed with a very gifted therapist and feel like I have a magic ace up my sleeve knowing that she’s in my corner. To round out the trifecta is a supportive and accessible OB/GYN that will see you and discuss your options if you aren’t feeling yourself.

I have been blessed with an iron clad support team all around and as wonderful as that is I realize that the sad truth is my situation is the exception rather than the norm. There have been heartbreaking stories about women trying to access care or medication only to be ignored or treated like a criminal in need of a psych hold. There really needs to be a better understanding about postpartum mental health and women supporting each other through it. Educate yourself on some of the symptoms and differences between postpartum mental health issues and baby blues.

The “4th Trimester” is a time to ease back into life, try not to over due it, and give yourself time to heal. Something I need to remind myself regularly, so you’re in good company!

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Without further ado

This is a Birth Story

After weeks of Prodromal Labor, a couple rounds of intense hours of thinking baby was coming only to have contractions spread out again… we made it to 40 weeks and induction. I joked that I just needed my water broken and that ended up being not too far from the truth!

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I checked in to the hospital (Seton Williamson) Friday, January 12th, around 7:20 am in the morning. Once all of the monitors were placed I was having mild contractions every 7 minutes. Activity on my part going into the induction is an excellent sign that my body is ready, as if the previous weeks weren’t signs toward that already. My amazing nurse, Tamara, placed my IV on the first try with only minimal digging! My previous two births were not nearly as successful (3 sticks and lots of bruising).

 

Dr. Chao came in and gave me the option to start with pit then break my water around lunch time, OR start with breaking my water then see if things progress after two hours and if not, start pit. I chose to start with breaking my water because I’ve been saying for days that all I needed was for my water to break. My cervical exam put me at 5 cm, 75%, and +2 station and they broke my water at 8:30 am. There was A LOT of fluid and moderate meconium. Baby was still showing signs of being very healthy, but I knew with the moderate meconium we were going to work to get him born in an efficient manner.  

Contractions picked up intensity and frequency pretty quickly to 2-3 minutes apart and breathing through them for just over 2 hours so they held off on pit as my body was doing a good job on its own so far.

Around 11:00 am my awesome friend and doula, Leticia, arrived with her bag of tricks. She plugged in a diffuser with “Citrus Bliss” that smelled absolutely wonderful and put me in a happy place. We were joking together between contractions which was nice.

Amy and Al were all set up in their own room across the hall from my room. My husband, Brandon, had to run out to take care of a few things at home really quick (we live 5 minutes away). He talked to Amy and Al about getting out of the hospital for a little bit to go do something or grab a bite to help pass a little time while I focused on labor. So they ran an errand at 11:30 am.

 

Between 11:00 – 11:45 am, my contractions spread back out from 2-3 minutes apart to 5 minutes apart. I told Brandon that with the meconium I expected they’d come in and want to start pit to keep things moving. At noon I was hooked up to pit at a 2 to get things back into gear. We all joked that I just needed to smell it though because they barely administered a cc. Contractions quickly jumped into transition mode. By 12:45 pm Brandon was trying to get a hold of Amy and Al to get them to the hospital ASAP because things were progressing really fast.

10 minutes later, once baby moved past my tail bone, I was making pushing sounds but everyone said not to push until I was checked which made me upset because being told not to push is the worst thing ever! The nurse checked me while I kneeled on the bed and said I was 8cm, almost complete with a little lip, and baby was at +1. They told me not to push yet which made more noises.

Dr Chao came by to check in and heard the sounds I was making so she also checked and I was already 9.5 and complete so they jumped into getting the bed ready for delivery while my body started pushing on my hands and knees. After that contraction they turned me around to get into a better pushing position while also trying to get baby’s heart beat. I almost smacked my sweet nurse because the pressure of the Doppler on my lower abdomen while pushing out a baby hurt! Thankfully I was too busy trying to break the bed rails so my hands were busy. Dr Chao told me with the next contraction I could push as much as I wanted, so I did! With Amazonian raw strength through that entire contraction I pushed out the biggest baby I have delivered and didn’t tear!

 

Samuel Finn Bakhit was born at 1:06 pm with the biggest beautiful umbilical cord I have ever seen. He was placed up on my chest and less than 5 minutes later his parents came racing into the room. I was too shaky to hand Samuel over so I asked the nurse to help. She had Amy sit in the rocking chair and handed him over so they could get some immediate skin to skin bonding. After I delivered the placenta and they got me covered up a little, a little parade followed Samuel across the hall to get his stats.

10 lb 1 oz, 20 inches long, with a 15 inch head.

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Leticia stayed with me for a little while and helped with the murder scene I made in the bathroom with my first attempt to pee without something sitting on my bladder. After that debacle I went ahead and took a gloriously cleansing shower.

After a little discussion my first postpartum meal was decided and Brandon ran to pick up my first delicious sushi in 10 months. So much love for this wonderful man of mine.

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Once all of the excitement started to die down, Leticia went home with a huge hug from me. Then Amy and Al walked across the hall with Samuel for a little visit.

My husband, doula, nurse, and OB were all so amazing and I don’t think it would have been as smooth or fast without them all there working together as a team supporting me. This truly was the magical experience I had envisioned. Birth is a painfully messy affair but it can be the most empowering and beautiful experience of your life as well.

 

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Brandon went home for the night to take care of our girls and dogs and to give me a chance to rest. I did get in my tradition of a tuna fish sandwich for dinner. Silly little thing that started out of necessity after delivering my first daughter and has stuck with each birth since.

Then glorious triumph I was able to have my IV removed. Always a favorite moment.

 

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Saturday was a busy morning with visits from the nursing staff, social worker, my amazing therapist, on call Doctor, and my girls. There was some concern with my blood pressure but with instructions to take it easy (I don’t have much of a choice on that one at the moment!) and symptoms to watch out for, I was allowed to be discharged around 1:30 pm.

Samuel and Family (ah! Family! <3) will hopefully get to go home later today. After everybody gets some healing, rest, and settling in together for a few days, we are going to have a nice family dinner to celebrate this beautiful journey.

 

Almost… There…

Breathe, relax, avoid my cell phone, and rotate through exercises.
That is my current situation.

Yes, I am still pregnant.
That seems to be the burning question of the moment.

This past week has been very long and eventful. Last Saturday evening as bed time was approaching for my girls, contractions started to pick up. I scurried them off to bed as quick as I could (which is never all that fast) and reached out to my doula. The contractions very quickly became very strong and were bringing me to my knees on the floor of my bedroom. I’ve experienced Pitocin induced contractions and natural, these were definitely of the exorcism level that Pitocin creates. I text my husband to please come home from his social outing and sent a message to Amy and Al to let them know that contractions were progressing but that I was going to try drinking a bunch of water and taking a hot shower to see if it would calm things down. My husband came home to me squatting in the shower crying through another contraction. He said, that’s it, we’re going to the hospital. I said some childish things about not caring how far apart the contractions were and that I didn’t want to go to the hospital because it wasn’t supposed to happen like this, which only solidified his reasoning for going. I would have done the same thing in his shoes. He took over updating Amy and Al, sent a message to a friend of ours to come stay at the house with the girls, and ran around grabbing the missing things from our hospital bags while I continued to work through those horrible contractions. By the time our friend arrived, the contractions had started to spread back out a little but hadn’t reduced intensity at all. Every time I would start to second guess the necessity to go in, another one would hit and leave me tearfully breathless. So, off we went.

We got to the hospital not too long before my backup doula arrived (my primary was still on vacation). The nursing staff was amazing and got me admitted pretty quickly. I had a few contractions while getting changed and monitors set up but then after that they started to spread out to a pretty consistent 10 minutes apart. The nurse waited a little bit before my first cervical check and announced that I was 3cm, 20% effaced, and baby was at a -2 station. The plan was to let me labor while being monitored for another hour or two and check to see if there was any progression. I moved to a ball and ditched the gown because I was pretty hot (typical M.O. for me) and proceeded to visit with my doula and husband. Contractions stayed at 10 minutes apart but also started to reduce intensity. I was pretty torn between wanting to progress labor and wanting to put on the breaks. Ultimately, there was no further progression. The nurse said I was more than welcome to stay as long as I like, or go home and try to get some sleep. I opted for my own bed around 12:30 am.

In the midst of all this madness, Amy and Al gathered their things and got in the car to drive down from Omaha to Austin. Weather was a little rough which meant slower going and there was holiday traffic because this was leading into New Year’s Eve day. All in all it was probably best that they were able to get to town a little earlier than planned with the way my body has been behaving. It certainly has given me a peace of mind to not worry about the distance.

Our girls ended up staying the day and through NYE at our friend’s house to give me the opportunity to rest and in the event that things kicked back into high gear. The hospital run, because I don’t want to call it a “false alarm”, was exhausting physically and emotionally so I was very appreciative of the extra rest. Amy and Al got into town on the afternoon of NYE. I suggested they rest too after the road trip and that all of the signs are pointing to a night time delivery anyway.

We have been able to go to lunch a couple of times and get in some nice visiting. The other big plus is that they were both able to attend the OB appointment and meet Dr. Choa in person before the big day. Dr. Choa has been great all along but I really appreciated how she handled our appointment. She made it clear that I am her patient but that it is their day too and she wants to make sure everything goes as smoothly as possibly for all parties involved at the time of delivery. I was monitored for about 15 minutes for a nonstress test after all of the activity of the previous days and week. Next up was a cervical check. Dr. Chao asked Amy & Al to step out for that part and after to give me a chance to get dressed again. Thankfully there was some progress since Saturday night (the appointment was Thursday morning). I was dilated to 3.5 cm (she was able to stretch me to 4 cm), 50% effaced, and baby was firmly at -3 station. While in there, Dr. Chao did a “thorough” sweep of my membranes.

We’re all hoping that he comes on his own very soon, but in the event he isn’t here by Thursday then there will be an ultrasound and OB appointment followed by induction. I would really like to avoid the induction if at all possible and have been tapping into all of my natural and homeopathic remedies to encourage downward movement. The last three nights have been especially intense and his lowered position is making walking more and more difficult. All signs that good things are happening, they are just taking their sweet time. I jokingly told my sister that I wish I could go hide like a cat and about the time people start noticing there would be a baby. Little jokes like that are helpful though because it lifts my mood a bit while I’m trying desperately not to be a bitter pot that is being closely watched from all angles.

Hopefully my next update will include a birth story.